Comparison of Tracheal Extubation Comfort between Two Endotracheal Tube Filling in Laparoscopic Cholecystectomy

Background: Post-intubation airway complications such as cough and sore throat are common complaints after anesthesia. After intubation, filling the endotracheal tube will close the tube space and stimulate the endotracheal tube. It is used to fill the cuff with air or liquids such as normal saline, lidocaine, etc. The purpose of this study was to compare the comfort of tracheal extubation between the two methods of filling the tracheal cuff with lidocaine 2% and filling with air in patients undergoing laparoscopic cholecystectomy.Methods and materials: In this single-blind clinical trial study, 70 patients were randomly divided into two groups of air and lidocaine. In the lidocaine group, the endotracheal tube cuff was filled with 2% lidocaine and in the air cuff group the cuff pressure reached 20 to 25 cm of water. Blood pressure and heart rate of patients before induction, after induction, 30 and 60 minutes after and before and after extubation, as well as complications of intubation including bucking, cough and sore throat during recovery, 6 hours and 12 hours later were compared. Data were analyzed using SPSS software version 16.Results: The results of this study showed that there were no significant differences in heart rate at different intervals of the study including pre-induction, post-induction, 30 and 60 min, before and after extubation. But the systolic and diastolic blood pressure after extubation were significantly lower in the lidocaine group than in the air group, although at other intervals there was a significant difference between the two parameters in the study groups. After extubation, sore throat complications were significantly lower at all study intervals.Conclusion: According to the results of the same study, it seems that filling the cuff with lidocaine over the air leads to more hemodynamic stability and less side effects after extubation.Keywords: Intubation, Lidocaine, Complication

Effect of addition of Ondansetron or Magnesium to Lidocaine on duration of analgesia of intravenous regional anesthesia in elective upper extremities surgery: comparative study.

BackgroundThis study aimed at evaluating and comparing the effect of ondansetron and magnesium added to lidocaine on intravenous regional anesthesia (IVRA) in the surgery of upper extremity.Settings and design The current randomized, clinical trial was conducted on 45 patients considered as candidates for upper extremities surgery in Qazvin, Iran. The patients were randomly assigned into three groups. Group C only received 3 mg/kg lidocaine, group O lidocaine + 4 mg/kg ondansetron, and group M lidocaine + 7.5 mL magnesium sulfate 20%. Then, the sensory and motor blocks, tourniquet pain, the amount of administered extra fentanyl, pain intensity, and other parameters involved in analgesia were analyzed in the groups using the statistical tests.ResultsThe time for onset of sensory and motor blocks in group M was significantly shorter than the groups C and O (P <0.05). In terms of the recovery time of sensory block, the time of group O was significantly longer than those of groups M and C (P <0.05). The amount of administered extra fentanyl and tourniquet pain after block in groups O and M were significantly lower than those of group C (P< 0.05). No significant difference was observed in postoperative pain and other features among the groups (P >0.05).ConclusionMagnesium had more rapid effectiveness and ondansetron had prolonged postoperative analgesia. Although the induced analgesia relatively improved the intensity of pain, it failed to maintain its supremacy in postoperative pain. To obtain more conclusive results, further studies are required.BackgroundThis study aimed at evaluating and comparing the effect of ondansetron and magnesium added to lidocaine on intravenous regional anesthesia (IVRA) in the surgery of upper extremity.Settings and design The current randomized, clinical trial was conducted on 45 patients considered as candidates for upper extremities surgery in Qazvin, Iran. The patients were randomly assigned into three groups. Group C only received 3 mg/kg lidocaine, group O lidocaine + 4 mg/kg ondansetron, and group M lidocaine + 7.5 mL magnesium sulfate 20%. Then, the sensory and motor blocks, tourniquet pain, the amount of administered extra fentanyl, pain intensity, and other parameters involved in analgesia were analyzed in the groups using the statistical tests.ResultsThe time for onset of sensory and motor blocks in group M was significantly shorter than the groups C and O (P <0.05). In terms of the recovery time of sensory block, the time of group O was significantly longer than those of groups M and C (P <0.05). The amount of administered extra fentanyl and tourniquet pain after block in groups O and M were significantly lower than those of group C (P< 0.05). No significant difference was observed in postoperative pain and other features among the groups (P >0.05).ConclusionMagnesium had more rapid effectiveness and ondansetron had prolonged postoperative analgesia. Although the induced analgesia relatively improved the intensity of pain, it failed to maintain its supremacy in postoperative pain. To obtain more conclusive results, further studies are required

Relationship Between Upper Airway Ultrasound Parameters and Degree of Difficult Laryngoscopy for Endotracheal Intubation

Background Limited research has been conducted on the role of ultrasound in predicting difficult laryngoscopy (DL). This study aimed to evaluate the predictive values of upper airway ultrasound parameters for the degree of DL during intubation. Methods and Materials This observational-prospective study was performed on 120 patients requiring intubation during elective surgery. Initially, the degree of DL was assessed by the Mallampati Scale. The patients' neck circumference was then measured and recorded.  Ultrasound was used to determine the Hyomental distance in the neutral position (HMDN) and in the head extension (HMDE), as well as tongue width (TW), tongue thickness (TT), oral cavity height ratio (OCH), the amount of soft tissue (ST), and the Tongue thickness-to-oral cavity height ratio (TT/OCH) was used. Afterward, the patients underwent general anesthesia and were intubated. The degree of difficult intubation was measured based on the Cormack-Lehane classification system, according to which the patients were divided into easy and difficult laryngoscopy groups. Finally, the effectiveness of the two methods of ultrasound and intubation was compared. Results The Cormack score and Mallampati class recorded intubation difficulty as 28.3% and 30.8%, respectively. According to the Cormack score, only the neck circumference was significantly associated with intubation difficulty (P = 0.002). In terms of Mallampati class, the neck circumference and HMDN, HMDE, TT, OCH, and ST were significantly associated with the degree of DL (P <0.05). The predictive value of ultrasound parameters for the degree of DL was low based on both of the criteria (AUC <0.7). Conclusion The results showed that although Mallampati class lacked the desirable accuracy, it provided a better predictive measure for the degree of DL during intubation compared to the Cormack score

Effect of Ketofol instead of Propofol on hemodynamic stabilization for induction of Anesthesia in Laparatomy

Introduction: Hemodynamic alterations are a common complication during anesthetic induction with intravenous anesthesia. Hypotension due to propofol injection may be very severe in cardiac vascular patient. Ketamine produces the significant increasing but temporary in systematic blood stream, heartbeat, cardiac output through central sympathetic stimulation.Objective: To determine effect of ketofol and propofol for induction of anesthesia on hemodynamic changes during induction of anesthesiaMethods: In a randomized cinical trial study 96 patient who were candidate for laparotomy enrolled and divided into two random group of propofol (48 person) and ketofol (48 person). Hemodynamic changes were recorded and examined after induction, after intubation and 5 and 10 minutes after intubation.Results: Heart rate was significantly variable in propofol group compare to ketofol group. Systolic, Diastolic, and mean arterial blood pressure was not significantly changed during time period of recording in ketofol group. However, blood pressure was significantly changed during the study in propofol group.Conclusion: ketofol is a proper alternative to propofol to stabilize heart rate and blood pressure in laparatomy

Effect of addition of ondansetron or magnesium to lidocaine on duration of analgesia of intravenous regional anesthesia in elective upper extremities surgery: Comparative study

Background: This study aimed at evaluating and comparing the effect of ondansetron and magnesium added to lidocaine on intravenous regional anesthesia (IVRA) in the surgery of upper extremity. Methods and Materials: The current randomized, clinical trial was conducted on 45 patients considered as candidates for upper extremities surgery in Qazvin, Iran. The patients were randomly assigned into three groups. Group C only received 3 mg/kg lidocaine, group O lidocaine +4 mg/kg ondansetron, and group M lidocaine +7.5 mL magnesium sulfate 20%. Then, the sensory and motor blocks, tourniquet pain, the amount of administered extra fentanyl, pain intensity, and other parameters involved in analgesia were analyzed in the groups using the statistical tests. Results: The time for onset of sensory and motor blocks in the M group was significantly shorter than the groups C and O (p<0.05). In terms of the recovery time of the sensory block, the time of group O was significantly longer than those of groups M and C (p<0.05). The amount of administered extra fentanyl and tourniquet pain after block in groups O and M were significantly lower than of group C (p<0.05). No significant difference was observed in postoperative pain and other features among the groups (p>0.05). Conclusion: Magnesium had more rapid effectiveness and ondansetron had prolonged postoperative analgesia. Although the induced analgesia relatively improved the intensity of pain, it failed to maintain its supremacy in postoperative pain. To obtain more conclusive results, further studies are required. Keywords: Bier Block, Ondansetron, Magnesium, Lidocain